The Perception of Cancer Risk in Patients with Barrett's Esophagus

描述(由申请人提供)： Barrett‘s食道(BE)是一种易患食管腺癌的癌前病变，定义为食管肠化生。在无异型增生的BE环境中，癌症的发病率很低，大约为0.005例/病人年。我们以前已经证明，平均而言，BE患者大大高估了他们患癌症的风险，而且高估风险与增加资源利用的趋势有关，如内窥镜检查和临床就诊。此应用程序的目标是：1)在多中心研究中评估非发育不良BE受试者患食管腺癌的感知风险；2)评估风险感知与这些受试者资源利用之间的关系；3)开发基于互联网的、自我导向的教学干预措施，用于后续RO1应用中对BE受试者的管理。研究人员是经验丰富的临床研究人员，在行为科学专家的帮助下，在BE有长期的调查记录。这项计划拨款将提供一种机制，以确认从初步数据中观察到的关于Barrett‘s食道环境中患者癌症风险高估的观察结果，并将检查风险认知和医疗保健利用之间的关联。它还将提供手段，在经过充分验证的医疗行为模式的框架内，开发旨在解决患者对风险的误解的干预措施。这笔赠款将允许改进疾病定义、结果衡量标准、样本量和分析计划，并解决随后应用该赠款中制定的干预措施的多中心试验的可行性问题。由此产生的研究应用程序将评估与健康相关的生活质量、与健康相关的焦虑和医疗保健利用情况。

DESCRIPTION (provided by applicant): Barrett's esophagus (BE), defined as the development of intestinal metaplasia in the esophagus, is a premalignant condition that predisposes to adenocarcinoma of the esophagus. The incidence of cancer in the setting of BE without dysplasia is low, approximating 0.005 cases/patient-year. We have previously demonstrated that patients with BE on average greatly overestimate their risk of development of cancer, and that over-estimation of risk was associated with a trend toward increased utilization of resources, such as endoscopy and clinic visits. The objectives of this application are: 1) to assess the perceived risk of esophageal adenocarcinoma in subjects with non-dysplastic BE in a multi-center study, 2) to assess the relationship between risk perception and the utilization of resources in these subjects, and, 3) to develop an internet-based based, self-directed teaching intervention to be administered to subjects with BE in a subsequent RO1 application. The investigators are experienced clinical researchers with a long record of investigation in BE, aided by experts in behavioral sciences. This planning grant would provide a mechanism to confirm observations from preliminary data regarding the overestimation of patients' cancer risk in the setting of Barrett's esophagus, and would examine the association between risk perception and healthcare utilization. It would also provide the means to develop an intervention designed to address patients' misunderstandings of risk, in the framework of a well-validated model of healthcare behavior. This grant will allow refining of disease definitions, outcome measures, sample size, and analysis plans and to address feasibility issues of a subsequent multi-center trial applying the intervention developed in this grant. The resultant study application will assess health-related quality of life, health-related anxiety and healthcare utilization as outcomes.